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Mobile Health Gets Political
OCT 9, 2013 12:19pm ET
The FDA’s recent release of its guidance on mobile medical applications met generally widespread support among those in industry and medical practice alike. With the clarification of regulatory guidelines, industry experts predicted a surge of new mobile applications and physicians welcomed better understanding of the role of their existing mobile devices.
While the grey area of uncertainty surrounding the necessity of FDA clearance has been reduced and physicians and patients can breathe a sigh of relief knowing that there may be federal validation for new and existing mobile healthcare tools, the document will have some rarely discussed consequences. While the mobile healthcare app market free-for-all was in absolute need of regulatory and future guidance, it’s important to note the winners and losers in the departure from a completely open playing field.
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Watson-like tech tackles readmissions
Posted on Oct 11, 2013
By Bernie Monegain, Editor
UNC Health Care is using IBM big data analytics to help hospital workers reduce costly and preventable readmissions, decrease mortality rates and improve patient care.
UNCHC is employing an IBM Smarter Care solution, which enables clinicians to quickly access and analyze critical patient information using natural language processing similar to what’s used in IBM Watson technology. With the ability to see and interpret both structured and unstructured data, UNCHC can now identify high-risk patients, understand in context what is causing them to be hospitalized, and then take preventative action.
More than 80 percent of an institution’s data today is unstructured – meaning it cannot readily be collected and analyzed using standard methods, IBM executives note in a news release. In healthcare, this is in the form of physician notes, registration forms, discharge summaries, phone calls, documents and more. In addition, medical literature is doubling every five years, making it difficult for clinicians to remain up-to-date with the latest scientific information.
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Telehealth: The Ultimate in Convenience Care
The demand for quick and convenient consultation with doctors has produced plenty of options.
October 9, 2013
Doctors and nurses can consult with patients over the internet.
Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. "You know what HD television looks like. You can actually see the pimples on the actors' faces," she says. "I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure." A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.
The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.
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Some say health-care site’s problems highlight flawed federal IT policies
By Craig TimbergLena H. Sun, E-mail the writers
Problems with the federal government’s new health-care Web site have attracted legions of armchair analysts who speak of its problems with “virtualization” and “load testing.” Yet increasingly, they are saying the root cause is not simply a matter of flawed computer code but rather the government’s habit of buying outdated, costly and buggy technology.
The U.S. government spends more than $80 billion a year for information-technology services, yet the resulting systems typically take years to build and often are cumbersome when they launch. While the error messages, long waits and other problems with www.healthcare.gov have been spotlighted by the high-profile nature of its launch and unexpectedly heavy demands on the system, such glitches are common, say those who argue for a nimbler procurement system.
They say most government agencies have a shortage of technical staff and long have outsourced most jobs to big contractors that, while skilled in navigating a byzantine procurement system, are not on the cutting edge of developing user-friendly Web sites.
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What happened to Healthcare.gov?
Posted on Oct 11, 2013
By Mike Miliard, Managing Editor
It's been almost two weeks since Obamacare's federal insurance exchange website went live, was inundated with traffic, went weird, was taken down for maintenance, then came back online still filled with glitches. Why did such a crucial site fail at such a critical moment? And what are the lessons that can be learned?
When President Barack Obama rode to reelection in 2012, his campaign was widely praised for the preternatural talents of its IT team, for the innovative data platform (codename: Narwhal) that helped pinpoint and make the most of every last potential vote.
So why, after making it the centerpiece of his presidency and spending untold time and effort defending it from judicial and legislative challenge, has the administration seen the main website for Obama's signature achievement fail so badly at its moment of truth?
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Why US government IT fails so hard, so often
One hint: Windows Server 2003 is still good enough for government work.
The rocky launch of the Department of Health and Human Services' HealthCare.gov is the most visible evidence at the moment of how hard it is for the federal government to execute major technology projects. But the troubled "Obamacare" IT system—which uses systems that aren't connected in any way to the federal IT infrastructure—is just the tip of the iceberg when it comes to the government's IT problems.
Despite efforts to make government IT systems more modern and efficient, many agencies are stuck in a technology time warp that affects how projects like the healthcare exchange portal are built. Long procurement cycles for even minor government technology projects, the slow speed of approval to operate new technologies, and the vast installed base of systems that government IT managers have to deal with all contribute to the glacial adoption of new technology. With the faces at the top of agency IT organizations changing every few years, each bringing some marquee project to burnish their résumés, it can take a decade to effect changes that last.
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Government, industry need to act to avoid 'unintended consequences' of EHRs
October 8, 2013 | By Marla Durben Hirsch
A combination of government oversight and industry action is needed to avert the "unintended consequences" of electronic health record use that adversely impact patient safety, according to Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association.
Bowman, writing in AHIMA's Perspectives in Health Information Management, warns that shortcomings in EHR design and implementation create not only safety, fraud and abuse problems, but also may serve as a barrier to EHR use and adoption.
"Although many system developers and policy makers believe that the risks of EHRs are minor and easily manageable, that is not the case," Bowman says. "Patient safety and quality of care are seriously compromised by flawed EHR system design or functionality or improper use. Failure to address information integrity issues in EHR systems will lead to spiraling, rather than declining, healthcare costs and medical errors as a result of the proliferation of new types of patient safety hazards."
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Clinical prediction rules could improve quality, reduce costs--if only docs would use them
October 8, 2013 | By Marla Durben Hirsch
Electronic health record systems integrated with clinical prediction rules (CPRs) can improve quality of care, contain costs and reduce overtreatment, according to a new study in JAMA Internal Medicine.
CPRs assess a patient's lab results, history and other factors and aid providers by estimating the probability of disease or potential response to a treatment.
A team that included researchers from Mount Sinai School of Medicine found that providers have yet to incorporate CPRs into their every day care. The researchers developed a randomized clinical trial to determine if CPRs were effective in face-to-face primary care settings and have an impact on how doctors order tests and prescribe medications.
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Breach has hospital using encryption
Posted on Oct 10, 2013
By Erin McCann, Associate Editor
Westmoreland, Tenn.-based HOPE Family Health is notifying 8,000 patients of a data breach after an unencrypted company laptop used by a finance department employee was stolen.
On Aug. 4, officials learned the laptop was stolen from the employee's home during a series of neighborhood burglaries. Reportedly, following a police investigation, several individuals were arrested and charged with possible involvement, officials say.
The laptop contained patient names, Social Security number, proprietary financial records, billings records, patient account information, dates of birth and addresses.
As a result of the data breach, HOPE Family Health officials have now put all digital private patient information on an encrypted server instead of individual computers. Additionally, all employees are required to attend information management training to ensure that they are aware of policies regarding safely handling patient data.
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Big data sets sights on heart disease
Posted on Oct 10, 2013
By Mike Miliard, Managing Editor
The National Institutes of Health has given a $2 million research grant to IBM, Sutter Health and Geisinger Health System as they partner to develop data analytics tools to help physicians detect heart failure sooner.
The funding will go towards development practical and cost-effective early-detection methods for primary care practices with an electronic health record system, officials say. The health systems hope to arrive at a deeper understanding of how to use the data contained within EHRs and advanced analytics to help detect heart failure earlier.
Another goal is to look for ways to help other hospitals and health systems integrate big data strategies into primary care, helping doctors and caregivers use evidence-based insights to better partner with patients and identify more tailored treatment options and holistic approaches to disease management that are personalized for each individual.
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'Note bloat' putting patients at risk
Posted on Oct 10, 2013
By Neil Versel, Contributing Writer
Healthcare organizations with long-established electronic health records run the risk of "note bloat" and compromised patient safety unless they standardize physician documentation procedures and limit the amount of cutting-and-pasting doctors have to do, attendees of CHIME's Fall CIO Forum heard here at a session on Oct. 9.
"It's been challenging for docs and healthcare systems in general … to produce a document that reflects the patient story in the most concise, complete and informational way," said Jody Cervenak, principal of Pittsburgh-based health IT consulting firm Aspen Advisors.
Cervenak quoted 17th Century French mathematician and philosopher Blaise Pascal, who wrote, "I have made this letter longer than usual, only because I have not had the time to make it shorter."
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Farzad Mostashari: Let me be blunt
October 10, 2013 | By Gienna Shaw
No longer constrained by the talking points that are part and parcel of life in public office, Farzad Mostashari, M.D., took the stage at the annual CHIME CIO forum in Scottsdale, Ariz., on Wednesday and spoke frankly about barriers to care transformation, limits of healthcare technology and other worries he has about the healthcare system.
And for the first time since stepping down as the national coordinator for health IT, he gave an unofficial answer to the question everyone always asks in some form or another and about one program or another: Will Meaningful Use Stage 2 be delayed?
"I'm no longer in public office and I can be blunt," Mostashari (pictured right with CHIME President and CEO Russell Branzell) said. And blunt he was.
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Beginning an Era of Clinical Quality Measure Alignment: Are You Ready?
Thursday, October 10, 2013
Starting in 2014, CMS allows hospitals to voluntarily submit clinical quality measure (CQM) data electronically that will simultaneously satisfy quality reporting requirements for both the Medicare Electronic Health Record Incentive and the Hospital Inpatient Quality Reporting programs. While CMS is very clear that it intends to make an electronic submission of CQM data a regulatory requirement in the future, in 2014 hospitals may choose to continue to separately report CQMs for each program.
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For $49, a doctor will see you now -- online
American Well unveils a new service that connects consumers directly to physicians through their mobile devices for advice -- and sometimes even for diagnoses and prescriptions.
When Dr. Teresa Myers took a call from a woman who thought she'd gotten strep throat right smack in the middle of an important business trip, the Akron, Ohio-based family medicine physician who loves telemedicine so much she actually does it in her spare time didn't mean to scream.
But when the patient -- hoping a doc could diagnose her problem via her iPhone camera so that she could get a prescription without going to an ER -- pointed her phone's flashlight toward the back of her throat, Myers couldn't restrain herself.
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Health Care: Big Data’s Next Frontier
OCT 8, 2013 3:37pm ET
Better medical outcomes at lower cost -- these are the goals of modern health care. Data and analytics can play a major role in helping to achieve these objectives by enabling evidence-based decision making in the industry. Alas, with but a few exceptions, that promise has not yet been delivered. Why?
Health care is a risk-averse industry. With decisions that can have life and death consequences, new business models and processes are adopted cautiously. Unfortunately, health care has not widely taken to many technologies now pervasive in the commercial world. And data that is common – claims, clinical, electronic health records, genetic, and personal health device-generated -- exist primarily in non-integrated silos.
The good news is that the landscape is starting to change as health information exchanges assume the role of clinical data repositories from multiple providers, and accountable care organizations begin to integrate payment and quality measures. Yet while insurance companies, researchers and clinicians have made significant contributions to the industry through analysis of their respective data, the ultimate promise lies in integrating these disparate data sets to gain new knowledge.
Readers with experience in the health care industry might now be thinking “Privacy!”
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Cleveland Clinic Shares Hard-Learned Portal Lessons
OCT 8, 2013 3:40pm ET
Cleveland Clinic’s first effort at building a physician portal to provide performance and quality reports did not go well. Leaders from the large health delivery system shared those lessons at the Medical Group Management Association conference in San Diego.
According to Brett Young, director of business intelligence, the first portal, launched in 2006, met the goals of providing reports but fizzled miserably when it came to user acceptance. Reason? First and foremost, the metrics offered reflected generic enterprise level data not necessarily tailored to the individual physician’s practice. Beyond that, the reports lived in a silo, and were not part of the physician’s annual performance review at the Clinic. The scorecards were also obtrusive, popping up every morning during the physician’s log-in. “In-your-face analytics don’t work very well,” Young said.
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NHS England says no to VistA
30 September 2013 Rebecca Todd
NHS England has decided not to pay £7m to anglicise the US Veterans Health Administration’s open source electronic medical record, VistA.
Instead, it will create a framework for NHS trusts to buy open source system support, hosting and change management.
Beverley Bryant, NHS England’s director of strategic systems and technology, told EHI that two UK companies and one NHS trust have shown a serious interest in open-sourcing their health IT systems. One of those is IMS Maxims.
Guidance released by NHS England in July said it would spend some of the £260m technology fund on exploring the creation of an NHS VistA.
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How Technology is Helping Nurses Build Patient Engagement
By Debra Wood, RN, contributor
October 7, 2013 - Engaging patients in their own health care and helping them work in tandem with the care team has become one of the key themes in modern medical practice. The goal is to prevent illness, promote wellness and improve health outcomes, and nurses have a key role to play. They are being asked to expand their normal educational role, helping patients care for chronic conditions and make lifestyle changes--often with the aid of technology.
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Study: ePrescribing Reaches a Tipping Point
October 8, 2013 by Gabriel Perna
More than half of people who write prescriptions are now doing so electronically, representing an eightfold jump from four years ago, a study published this month in The American Journal of Managed Care reveals.
The increase came after the Centers for Medicare & Medicaid Services (CMS) instituted the Electronic Prescribing (E-Prescribing) Incentive Program in 2009. Using data from the Arlington, Va.-based ePrescribing network provider, Surescripts, the researchers looked at how ePrescribing has risen from December 2008 to 2012.
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EHRs, Red Tape Eroding Physician Job Satisfaction
John Commins, for HealthLeaders Media , October 9, 2013
Problems with electronic health records systems and the overall burden of rules and regulations imposed by payers and other entities are having a deleterious effect on the professional satisfaction of medical doctors, survey results find.
Physicians are most satisfied when they deliver high quality care to their patients, but problems with electronic medical records and red tape are hindering their practices, a multi-state survey shows.
The RAND Corp. report was commissioned by the American Medical Association and surveyed hundreds of physicians in six states to identify the factors that influence professional satisfaction. The survey found that only 20% of physicians said they want to return to paper medical records.
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Docs 'stressed and unhappy' about EHRs
Posted on Oct 09, 2013
By Mike Miliard, Managing Editor
While physicians recognize the benefits of electronic health records, they also complain that many systems deployed nowadays are cumbersome to use and often act as obstacles to quality care, according to a new report from RAND Corporation.
The study makes the case that being able to provide high-quality healthcare is a primary driver of job satisfaction for doctors, and that anything that hinders that ability is a source of stress. RAND officials say the findings suggest potential early warnings of deeper quality problems developing in the U.S. healthcare system.
"Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care," said Mark Friedberg, MD, the study’s lead author and a natural scientist at RAND. "If their perceptions about quality are correct, then solving these problems will be good for both patients and physicians."
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HIMSS Innovation Center opens its doors
Posted on Oct 08, 2013
By Bernie Monegain, Editor
The HIMSS Innovation Center opens today in Cleveland, a city, known around the world for the Cleveland Clinic and the Rock and Roll Hall of Fame, and one that prides itself on being a city of firsts.
HIMSS leaders who describe their 50,000-plus member organization of health IT professionals as "cause-based," make no bones about their intent to shake things up in healthcare – more than a little bit.
They pepper their conversations with words and phrases like disruption, interoperability and health information exchange. Transformation of healthcare through information technology has served as HIMSS’ mantra since the beginning.
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EHR copy and paste? Better think twice
Posted on Oct 08, 2013
By Erin McCann, Associate Editor
Who would have thought that something so simple as copy and paste could have such serious consequences?
Speaking at the MGMA annual conference in San Diego this Monday, Diana Warner, director at AHIMA, confirmed the seriousness of inappropriately using copy and paste functions in electronic health records. And the government agrees -- it's no laughing matter.
Seventy-four to 90 percent of physicians use the copy/paste function in their EHRs, and between 20 to 78 percent of physician notes are copied text, according to a September AHIMA report.
It's become such a compliance and payment problem that the U.S. Department of Health and Human Services Secretary Kathleen Sebelius together with Attorney General Eric Holder wrote a letter last year to industry medical groups underscoring the seriousness of doctors "gaming the system, possibly to obtain payments to which they are not entitled."
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Care.data extractions on hold
4 October 2013 Rebecca Todd
Extractions of GP data for care.data have been halted while issues around patient awareness of the scheme are resolved.
Representatives from NHS England and the Information Commissioner's Office presented on care.data in what was, at times, a tense session at the Emis National User Group conference in Nottingham yesterday.
The care.data programme will take a monthly dataset from practices covering patient demographics, events, referrals and prescriptions.
This will be linked with Hospital Episode Statistics and other data-sets to create new Care Episode Statistics.
GPs received a letter in late August explaining care.data and telling them that they have eight weeks to inform their patients about the scheme before extractions begin. Patients can opt out of the extracts via a Read code in their record.
However, GPs at the NUG said most patients will not be in their surgery within that eight week time period.
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http://www.healthcare-informatics.com/news-item/report-payers-providers-far-apart-analytics-adoption
Report: Payers, Providers Far Apart on Analytics Adoption
October 7, 2013 by Gabriel Perna
Healthcare providers are investing less into analytics and big data technology than payers, a new report from the Framingham, Mass.-based research company, IDC Health revealed.
The report, "Business Strategy: Health Plans and Providers Still Far Apart on Adoption of Big Data and Analytics,” included the findings of a survey of 3,500 IT decision makers, which revealed the disparity between the two. Eighty percent of payers surveyed said that they were allocating between 1-to-24 percent of their budget to analytics investments, while only 49 percent of providers are doing the same.
The difference is similar when it comes to big data analytics – 77 percent of health plans vs. 47 percent of payers. Over 40 percent of providers are not budgeting anything for Big Data and analytics, while only 14 percent of health plans are not investing in those areas. Similarly, the number of providers who don’t have a plan for big data or analytics outnumbers the number of payers who lack strategy.
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Readmissions 'Drop Like a Rock' with Predictive Modeling
Scott Mace, for HealthLeaders Media , October 8, 2013
Predictive modeling offers the key to understanding which healthcare services most affect utilization, readmissions, and payment, and how to tackle the outliers. These analytics are within the grasp of any healthcare system.
Somewhere out there, a hospital near you may be figuring out the technological secret to significantly lowering readmissions.
It isn't a secret easily uncovered, it takes hard work, and it takes working smart. But it can be done.
"Our admits and readmits have dropped like a rock," says Pamela Peele, PhD, chief analytics officer of the UPMC Insurance Services Division. UPMC is the short name for the University of Pittsburgh Medical Center, and Peele is one of two presenters in my October 28 HealthLeaders webcast.
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5 design flaws of HealthCare.gov
October 7, 2013 | By Ashley Gold
Amid the government shutdown and partisan games plaguing Washington, D.C., and the rest of the country, something is actually happening--online signups for the Affordable Care Act. HealthCare.gov is finally open for business, but how well is it designed?
The site has more than a few technical issues and was down for maintenance over the weekend. Glitches and technical issues in the health insurance exchange ran rampant on the opening day of the health insurance marketplaces with delays and server crashes as consumers overwhelmed computer systems.
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Patients like seeing lab results online
October 7, 2013 | By Ashley Gold
Patients able to view their lab results online overwhelmingly reacted positively to being able to do so, according to a new study published in the Journal of Participatory Medicine.
The study conducted an email survey of Kaiser Permanente members who had viewed at least one test result online in the last year, with 1,546 respondents. According to the study, survey participants reported, "high levels" of satisfaction, appreciation, calm, happiness and relief. Few were confused, upset or angry at being able to see lab results online.
After reviewing results online, the most common actions were discussing results with family and friends, looking up information online or making a graph of results over time. It was also important for doctors to set patients' expectations--in doing so, they were less likely to follow up on test results by calling, emailing or setting up new appointments, according to the study.
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Medical device security efforts ramp up
Posted on Oct 04, 2013
By Eric Wicklund, Editor, mHealthNews
A non-profit organization focused on Internet security is looking to develop a set of benchmarks to protect medical devices from potentially fatal cyber attacks.
Officials with the Center for Internet Security said the benchmarks would help device manufacturers and healthcare providers protect such devices as insulin pumps, pacemakers and defibrillators from being hacked or damaged by malware.
"The technological advancements that enable healthcare providers to embed life-saving devices and treat patients remotely are tremendous. We must do everything we can to protect those devices and the patients who rely on them," said William F. Pelgrin, CIS' president and CEO, in a news release.
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Health 2.0 Conference: Finding a Way Into Workflow and Life Flow
Monday, October 7, 2013
The seventh annual Health 2.0 conference took place under the shadow of major health care news last week: the opening on Oct. 1 of the state and federal health insurance exchanges and, on the same day, the start of the first government shutdown in 17 years, a result of continued congressional Republican opposition to the Affordable Care Act.
The California HealthCare Foundation, which publishes iHealthBeat, was a sponsor of the conference.
The conference, staged in the heart of Silicon Valley from Sept. 29 to Oct. 2, has grown exponentially since its early days. This year, it drew about 2,000 attendees, 140 demos and 200 speakers to the Santa Clara Convention Center. As in past years, developers and entrepreneurs dominated the stage and the audience. But the confab also attracted a mix of industry leaders, including large hospital systems, policymakers, medical device companies and insurers.
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Software, Design Defects Cripple Health-Care Website
Government Acknowledges It Needs to Fix Design and Software Problems
Six days into the launch of insurance marketplaces created by the new health-care law, the federal government acknowledged for the first time Sunday it needed to fix design and software problems that have kept customers from applying online for coverage.
The Obama administration said last week that an unanticipated surge of Web traffic caused most of the problems and was a sign of high demand by people seeking to buy coverage under the new law.
But federal officials said Sunday the online marketplace needed design changes, as well as more server capacity to improve efficiency on the federally run exchange that serves 36 states.
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Enjoy!
David.
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